Monday, January 09, 2017

Constructing a psychiatric future

I'm not sure if Nassir Ghaemi's letter to a medical student about choosing psychiatry as a speciality (see Medscapearticle) is another acknowledgement of mistakes in his career, like that of Robin Murray (see previous post). He says that DSM is "inherently unscientific" and psychiatric diagnoses are social constructions. From his point of view, psychiatry has pretended diagnoses are scientific facts. As he says, "This has been proven a lie, but we are unwilling to admit our self-deception". He seems to be saying it took him two decades to realise this.

I have several times mentioned the spat I had with Ghaemi when I reviewed one of his books (eg. see previous post). As I said in my review, he was one of the psychiatrists at the forefront of promoting bipolar depression, which I guess he now realises he helped to construct.

Actually, I don't think he needs to be quite so disillusioned about the prospects for psychiatry. It just needs to accept its inherent uncertainty (eg. see previous post).

2 comments:

From a reading of his CV it doesn't seem as though N.G. has had much actual contact with real people with the diagnoses he has helped to promote Rather they have been mainly for research and training of students. Who of course will themselves be promoting what he taught by now. Another 'mea culpa'?

A past President of the College of Psychiatrists, Mike Shooter, wrote a cry for change in an article in TheBmj in 2002 - 'Students Heads are So Fill of Lists, They have Forgotten How to Listen'. There were no responses either from colleagues or students. Even psychiatrist/psychotherapists who were strongly promoting talking therapies a few years ago are now pressing for research funding into neuropsychiatry. More Kudos in brain sciences than humanities. Better career prospects. Higher incomes. More invitations to national/international conferences/freebies/ more gongs. Where are the Mike Shooters these days....shame he made so little difference to the development of psychiatry since then despite his advocacy for users of services when so few were listening to what they had to teach 'professionals'.

'A remarkable and troubling new paper...Sprooten et al.’s analysis included 537 studies with a total of 21,427 participants. Five mental illnesses were examined: schizophrenia, bipolar disorder, major depressive disorder, anxiety disorders, and obsessive compulsive disorder (OCD)...

...The results were rather surprising. It turned out that there were very few differences between the different disorders in terms of the distribution of the group differences across the brain...In other words, there was little or no diagnostic specificity in the fMRI results...

...Sprooten et al. suggest that “the disorders examined here arise from largely overlapping neural network dysfunction”, in other words that the transdiagnostic trait is a neurobiological part of the cause of the various different disorders. But it seems to me that there’s no reason to assume this.

What if the common factor is more straightforward: something like anxiety or stress during the MRI scan?'